Is Carbon Monoxide Poisoning a Potential Trigger for Spontaneous Coronary Artery Dissection? A Case Report and Review of the Literature-Uncorrected Proof

Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal cause of acute coronary syndrome (ACS), often associated with younger individuals and women without traditional cardiovascular risk factors. Carbon monoxide (CO) poisoning, a known cause of systemic hypoxia, has been implicated in various cardiovascular complications; however, its role in triggering SCAD remains scarcely reported. We present the case of a 55-year-old woman who developed SCAD following acute CO poisoning caused by a domestic gas leak. The patient presented with altered mental status and respiratory failure, requiring hyperbaric oxygen therapy. Following stabilization, typical anginal symptoms emerged, with rising cardiac biomarkers suggestive of myocardial injury. Coronary angiography revealed spontaneous dissections in both the distal left anterior descending artery and the distal right coronary artery without critical flow limitation. The patient was managed conservatively with medical therapy and remained asymptomatic at six month follow-up. This case highlights the importance of considering SCAD in patients presenting with cardiac symptoms following CO poisoning and underscores the need for vigilance in atypical presentations of myocardial injury.

Keywords: Acute coronary syndrome, carbon monoxide poisoning, spontaneous coronary artery dissection